Prodromal dementia with Lewy bodies: a case series of the 3 prodromal types from clinical practice

Prodromal dementia with Lewy bodies (DLB) refers to a state prior to the onset of dementia with clinical signs or symptoms that may indicate the future development of DLB. Prodromal symptoms can include not only cognitive deficits but also a mix of clinical features including sleep disorders, autonomic dysfunction, and neuro-psychiatric disturbances. While diagnostic criteria for the subtypes of prodromal DLB were recently published, they are largely for use in the research setting. However, these diagnostic criteria have important implications for clinical practice. Helping clinicians to recognize prodromal stages of DLB can lead to identifying deficits sooner, improved patient and family counseling, and advance care planning. This case series presents examples of the 3 subtypes of prodromal DLB – mild cognitive impairment-onset, delirium-onset, and psychiatric-onset – to help clinicians identify individuals who may be on a trajectory to develop DLB

Human domination of the global water cycle absent from depictions and perceptions

International audienceHuman water use, climate change and land conversion have created a water crisis for billions of individuals and many ecosystems worldwide. Global water stocks and fluxes are estimated empirically and with computer models, but this information is conveyed to policymakers and researchers through water cycle diagrams. Here we compiled a synthesis of the global water cycle, which we compared with 464 water cycle diagrams from around the world. Although human freshwater appropriation now equals half of global river discharge, only 15% of the water cycle diagrams depicted human interaction with water. Only 2% of the diagrams showed climate change or water pollution—two of the central causes of the global water crisis—which effectively conveys a false sense of water security. A single catchment was depicted in 95% of the diagrams, which precludes the representation of teleconnections such as ocean–land interactions and continental moisture recycling. These inaccuracies correspond with specific dimensions of water mismanagement, which suggest that flaws in water diagrams reflect and reinforce the misunderstanding of global hydrology by policymakers, researchers and the public. Correct depictions of the water cycle will not solve the global water crisis, but reconceiving this symbol is an important step towards equitable water governance, sustainable development and planetary thinking in the Anthropocene

A water cycle for the Anthropocene

International audienceHumor us for a minute and do an online image search of the water cycle. How many diagrams do you have to scroll through before seeing any sign of humans? What about water pollution or climate change—two of the main drivers of the global water crisis? In a recent analysis of more than 450 water cycle diagrams, we found that 85% showed no human interaction with the water cycle and 98% omitted any sign of climate change or waterpollution (Abbott et al., 2019). Additionally, 92% of diagrams depicted verdant, temperate ecosystems with abundant freshwater and 95% showed only a single river basin. It did not matter if the diagrams came from textbooks, scientific articles, or the internet, nor if they were old or new; most showed an undisturbed water cycle, free from human interference. These depictions contrast starkly with the state of the water cycle in the Anthropocene, when land conversion, human water use, and climate change affect nearly every water pool and flux (Wurtsbaugh et al., 2017; Falkenmark et al., 2019; Wine and Davison, 2019). The dimensions and scale of human interference with water are manifest in failing fossil aquifersin the world’s great agricultural regions (Famiglietti, 2014), accelerating ice discharge from the Arctic (Box et al., 2018), and instability in atmospheric rivers that support continental rainfall (Paul et al., 2016).We believe that incorrect water cycle diagrams are a symptom of a much deeper and widespread problem about how humanity relates to water on Earth. Society does not understand how the water cycle works nor how humans fit into it (Attari, 2014; Linton, 2014; Abbott et al., 2019). In response to this crisis of understanding, we call on researchers, educators, journalists, lawyers, and policy makers to change how we conceptualize and present the global water cycle. Specifically, we must teach where water comes from, what determines its availability, and how many individuals and ecosystems are in crisis because of water mismanagement, climate change, and land conversion. Because the drivers of the global water crisis are truly global, ensuring adequate water for humans and ecosystems will require coordinated efforts that extend beyond geopolitical borders and outlast the tenure of individual administrations (Keys et al., 2017; Adler, 2019). This level of coordination and holistic thinking requires widespread understanding of the water cycle and the global water crisis. Making the causes and consequences of the water crisis visible in our diagrams is atractable and important step towards the goal of a sustainable relationship with water that includes ecosystems and society